kinds of family planning programs than for other health services; the program management should have a high and semi-autonomous status; and the costs should be considered as new and additional to those for other services.
(2) If a drop in birth rates results from the family planning program, the need for personal health services will be less than it would be with continuing high fertility. For example, in a country in which the level of health services is being doubled, a 25 percent decline in average rate of population growth would produce a 15 percent saving in annual health expenditures at the end of 20 years, compared to the expenditures required if the rate of population growth is unchanged. The effect on maternal and child health services will be proportional to the decline in birth rates and will be felt as soon as a decline occurs.
(3) The family planning program may compete with the personal health services for scarce medical facilities and personnel, including physicians and trained nurses. Where family planning programs and health services are combined, there may also be a direct competition for funds; the budget for an effective family planning program is likely to be at least half the health services budget in those developing countries that spend less than 1 percent of GNP on health. Competition for personnel, facilities, and funds will arise as soon as the family planning program is initiated, before it has had an appreciable effect on fertility. The extra demand for physicians can be minimized by employing family planning workers who are not physicians, but who have been especially trained to carry out the necessary physical examinations and other activities required in the family planning program. This has been tried successfully in Pakistan. Modern techniques for induced abortion greatly reduce the time requirements for physicians to perform abortions, and the number of days spent in hospitals by abortion patients.
Health Consequences of Density and Crowding
The commonly held view that crowding and population density, per se, have deleterious effects on health probably derives largely from four empirical observations: (a) Traditionally the densely populated (i.e., urban) areas have reported higher death and morbidity rates, (b) Industrialization and urbanization have frequently been followed by dramatic increases in death rates attributable to infectious diseases, (c) Studies of military training camps have reported exceptionally high rates of virus diseases, (d) In some laboratory studies, deleterious health consequences are noted as the number of animals housed together is increased.
The orthodox explanation for these observations is that crowding increases infectious disease, mainly through a greater opportunity for the spread of infection. For example, outbreaks of upper respiratory infection among recruits in military training camps are explained as the result of the herding